Bonitas PMB Care Plan Benefits is a Total ****

I am on the Bonitas Primary Plan, member number ***. As part of my chronic condition management, I receive a care plan from Bonitas, which is designed to cover treatment and tests received during my annual visit. According to the care plan, for Primary, BonStart, and BonStart Plus options, if clinical criteria are met, approved out‑of‑hospital tests and specialist consultations for the management of PMB conditions will be paid from both the approved PMB Care Plan and day‑to‑day benefits concurrently. The claim for this visit was R6222.80, of which Bonitas paid R5846.70, with zero payment required from me. However, this amount was paid entirely from my day‑to‑day benefits, which I believe is incorrect. Based on the care plan, the payment should have been split between the care plan and day‑to‑day benefits, not taken fully from my day‑to‑day benefits. This approach depletes my day‑to‑day benefits prematurely, leaving me unable to access other benefits later in the year. Despite assurances from call centre agents that payments are made from both the care plan and day‑to‑day benefits, the actual claim processing does not reflect this. The doctor is not being paid twice, and the care plan is not being utilised for its intended purpose.

Complaint History • Initial Complaint: Logged on 2 March 2026 ○ Query ID: 020326QFMSBP [MI***] • First Follow‑up: 11 March 2026 at 08h40 ○ Agent: Stewart ○ Feedback: Complaint has a 15 working day turnaround time, expected resolution by 23 March 2026 • Second Follow‑up: 24 March 2026 at 08h32 ○ Agent: Stewart ○ Feedback: Complaint escalated to PMB department for further review ○ Escalation Reference: Query ID – 110326QGGH9F [MI***]

Recourse Requested I require Bonitas to provide the following: 1. Purpose of the Care Plan – A detailed explanation of its intended role in managing chronic conditions. 2. Definition of “Paid Concurrently” – A full explanation of what this term means in practice, specifically in relation to the Primary Plan. 3. Payment Breakdown – Formal statements showing how payments were allocated between the Care Plan and day‑to‑day benefits for my chronic cardiologist visit on 26 February 2026. 4. Correction and Reimbur*****t – Adjustment of the claim to reflect correct allocation, and reimbur*****t of the full R5846.70 back into my day‑to‑day benefits.

I trust Bonitas will address this matter urgently and provide clarity on the resolution timeline.